| The coronary heart disease is one of the most important diseases whichthreaten the people’s lives and health in western developed countries. With theimprovement of living level and changes of life-style, the incidence of thisdisease has increased especially in young people in recent years. Acutecoronary syndrome (ACS) is a kind of critical condition of coronary heartdisease including unstable angina pectoris (UAP), ST-segment elevationmyocardial infarction (STEMI) and non-ST-segment elevation myocardialinfarction (NSTEMI) whose common pathological mechanism is differentdegrees of myocardial ischemic or infarction because of coronary artery lesion.Brain natriuretic peptide (BNP)，one of natriuretic peptide family, is animportant cardiac hormone whose production and secretion can be adjustedmainly by ventricular volume and tension of ventricular wall, which makes itbe a sensitive reflex of cardiac function. N-terminal pro-brain natriureticpeptide (NT-proBNP) is a polypeptide released at the same time and equalmole with BNP. NT-proBNP is considered to be more suitable for clinical testdue to its biological characteristics, such as big molecular mass, stablechemical quality and so on[1,2]. Both of them have been widely approved asbiomarkers to diagnosis and prediction heart failure by some guidelines andclinical practice[3-8]. A lot of researches done in recent years discovered thatplasma NT-proBNP in ACS is evidently higher than normal level and relatedto the order of severity of myocardial ischemic and lesion of coronary artery.Percutaneous coronary intervention (PCI) is the most effective measures forpatients in ACS in modern times. PCI can improve the situation of ischemicby coronary artery refusion, but also cause momentary ischemic at the sametime by balloon dilatation. We aim at assessing the applied value ofNT-proBNP in ACS by observing the changes of NT-proBNP in patients treated with coronary intervention and evaluating the relation between thechanges and ischemic.Objective：To observe the changes of plasma NT-proBNP in ACS treated withcoronary intervention and evaluate the relation between the changes andischemic, and assesse the applied value of NT-proBNP in patients with ACS.Method:1The subjects of studyA total of130patients with ACS, containing67with UAP、37withNSTEMI、26with STEMI, hospitalized in cardiovascular department andCCU of the Chaoyang Center Hospital within24hours after the onset of chestpain from April to November in2011were enrolled. Coronary angiography(CAG) for all patients and PCI for part patients with suitable conditions wereperformed after admission.2The measurement of NT-proBNPUlnar vein blood of3ml from each patient was collected intoanticoagulation tubes with ethlenediamine tetraacetic (EDTA) in the nextmorning after admission, before and24hours after intervention. Plasma wasseparated after centrifuging (3000r/min) for10minutes and stored at-20℃.Plasma NT-proBNP was measured with double antibody sandwich ELCA(electrochemiluminescence immunoassay) by Elecsys2010fully automaticbiochemistry analyzer and “NT-proBNP diagnostic kit” from Roche Company.3Color doppler diasonographyLeft ventricle ejection fraction (LVEF) was determined by PHILIPS iE33Doppler diasonography at24hours before and after intervention.4Coronary angiography and percutaneous coronary interventionAll patients accepted with routine CAG to determine the lesion aeteriacoronaria （stenosis≥70%）. PCI (PTCA+Stent) was performed on partpatients with suitable conditions. Make records of the number and position ofstents, frequency and lasting time of balloon inflation. 5Grouping(1) All patients were divided into CAG group and PCI group according tointervention results;(2) Patients in each group were divided into UAP group and AMI groupon the basis of pathology;(3) In PCI group, patients with UAP and one-vessel coronary diseasewere divided into LAD group (stent implantation in left anterior descendingcoronary artery) and non-LAD group (stent implantation in left circumflex orright coronary artery) in line with stent place;(4) In PCI group, patients with AMI were divided into early phase group(treated with PCI at the2-5th day after AMI) and late phase group (treatedwith PCI above5days) in accordance with the time of intervention; Patients informer group were divided into NSTEMI group and STEMI group based onpathology.6Statistical analysisNT-proBNP present positive skewness distribution and obey normaldistribution by logarithmic transform. Measurement data was expressed bymeans of mean±standard deviation（x±s）, and analyzed by SPSS11.5software. Spearman rank correlation was used to evaluate the relation betweentwo variables. T-test was used to compare the difference before and aftertreatment. The χ2test was applied to contrast interclass proportion. Allstatistical tests were2-tailed, P<0.05was considerred as statistical significant.Results:1Spearman rank correlation analysis displayed that NT-proBNP showedno significan relation to sex, heart rate (HR), systolic blood pressure (SBP),diastolic blood pressure (DBP)，total cholesterol (TC)，triglyeride (TG)，highdensity lipoprotein-cholesterol (HDL-C), low density lipoprotein-cholesterol(LDL-C)，creatinine (Cr)，blood urea nitrogen (BUN); NT-proBNP waspositively correlated with age (r=0.572, P=0.000), cTnT (r=0.297, P=0.020),CK-MB (r=0.284, P=0.026), and negatively correlated with left ventricularejection fraction (LVEF)(r=-0.324, P=0.017) and body mass index (BMI) (r=-0.255, P=0.032).2In CAG group, No significant change in NT-proBNP and LVEF wasnoted before and24hours after intervention both in UAP group and AMIgroup (P>0.05).3In PCI group, NT-proBNP with24hours past PCI in UAP group wasmuch higher than that before PCI when LVEF showed no marked differencesbetween the two times [(1067.6±603.7）pg/ml vs.(584.5±319.3) pg/ml,P=0.008;(0.57±0.05） vs.(0.59±0.04), P=0.652]； For patients withone-vessel coronary disease in UAP group, The increased ratio of NT-proBNPwas much bigger in LAD group compared to non-LAD group [(2.03±0.25) vs.（1.26±0.31）, P=0.005].4In PCI group, plasma NT-proBNP with24hours after PCI in patientswith AMI presented decrease in early phase group but increase in late phasegroup [（955.8±512.7） pg/ml vs.(1511.4±994.8) pg/ml, P=0.014;（1225.2±653.4）pg/ml vs.(918.7±466.4) pg/ml, P=0.021], LVEF had noremarkable change in both two groups [(0.57±0.03) vs.(0.56±0.05), P=0.686;(0.57±0.05) vs.(0.58±0.06), P=0.693].5In early phase group, patients with NSTEMI seemed to have a biggerdrop ratio in NT-proBNP than those with STEMI after PCI [(0.38±0.11) vs.(0.24±0.09), P=0.010].Conclusions:1Simple CAG had no influence on NT-proBNP in patients with ACS.NT-proBNP past PCI was significantly higher than before with no change ofLVEF, which shows that myocardial ischemia induced by balloon inflationduring intervention can raise plasma concentration of NT-proBNP withoutdepending on LVEF.2Plasma NT-proBNP increased much higher when ischemia happened inLAD, which presented that NT-proBNP in ACS was positively correlated withthe numbers of ischemia cardiac muscle and NT-proBNP maybe mainly comefrom the secretion of left ventricular anterior wall.3NT-proBNP in patients with AMI after PCI was related to the time of PCI and type of AMI, which means that PCI performed at the2-5th day fromthe onset of disease may be of greater benefit to patients with AMI especiallyto those with NSTEMI when compared to that done after5days. |
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